Should I see a leukaemia specialist?

The symptoms of leukaemia can be very similar to other, less serious, medical conditions. It can be very difficult for GPs to decide who may have a leukaemia and who may have something much less serious that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to treatment, such as antibiotics. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed and people needing urgent appointments wouldn't be able to get them. But it is very important for AML to be diagnosed and treated quickly.

Your GP may do a blood test. If the results show signs of acute myeloid leukaemia your GP should refer you to a blood specialist straight away. This is an immediate referral.

The National Institute for Health and Clinical Excellence (NICE) has produced referral guidelines for cancer and leukaemia. These guidelines help GPs decide who needs to see a specialist and how soon they should see them. According to the guidelines, an urgent referral means you should get an appointment with a specialist within 2 weeks.

If you have a combination of some of the symptoms below, your GP should take blood tests and make an urgent referral to a doctor specialising in blood diseases (a haematologist). The symptoms are

• An enlarged spleen for no obvious reason
• Unexplained extreme tiredness
• Weight loss
• Night sweats that drench you
• Itching all over
• Breathlessness
• Bruising easily
• Infections that keep coming back
• Bone pain
• Bleeding
• Pain in the tummy (abdomen)
• Swollen lymph glands

Your GP will look at your symptoms and decide which blood tests you need. You can have some of these symptoms with other less serious medical conditions. They do not always mean that you have acute leukaemia. The doctor’s experience helps them to work out who may have a serious illness and who is more likely to have something less serious that will go away on its own. Your doctor will take into account whether you have any of the risk factors for acute myeloid leukaemia.

The NICE guidelines suggest more specialised blood tests for particular symptoms such as

• Tiredness for no reason that doesn't go away or get better
• Bruising or bleeding for no reason
• Bone pain that doesn't go away

If your tests don't show anything the first time round, your GP may repeat them if your symptoms don't improve. We can’t give details of the blood tests here because they depend on your symptoms. You can talk to your GP about what the guidelines recommend in your case.

If you have swollen lymph glands, you should have more specialised blood tests and possibly referral to a specialist if the enlarged lymph glands are

• Widespread in your body
• Still there after 6 weeks or more
• Bigger than 2cm across

Or if you also have

• An enlarged spleen
• Bad night sweats
• Weight loss

If you are worried that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you. Then you may be able to decide together whether you need to see a specialist and if so, how soon.